1. Field of the Invention
The present invention relates generally to minimally invasive surgical methods and procedures. More particularly, the present invention relates to a transesophageal device which is used to retract a patient's stomach during the performance of a variety of laparoscopic and other surgical procedures.
Over the last several years, minimally invasive surgical procedures have become a viable alternative for a variety of open surgical procedures. Such minimally invasive procedures rely on introducing a viewing scope into the interior of a patient's body and performing the procedure using miniaturized instruments introduced through small incisions while observing the procedure on a video monitor. In this way, trauma to the patient and recovery times can be greatly reduced.
Of particular interest to the present invention, laparoscopic surgical procedures can be performed inside a patient's abdominal cavity by insufflating CO.sub.2 gas (applying positive pressure) in the abdomen in order to raise the abdominal wall over the peritoneum, thus providing a working space. A laparoscope and various miniaturized surgical instruments can then be introduced into the working space through trocars (which are small valved tubes) which pass through small incisions made in the abdominal wall. Laparoscopic gall bladder removal, referred to as laparoscopic cholecystectomy, is becoming commonly practiced, and other laparoscopic procedures are being devised and contemplated.
Many laparoscopic procedures will require stomach retraction in order to gain access to desired target locations in the abdomen. In open surgical procedures, stomach retraction is relatively simple since surgeons can manually grasp the stomach with their hands and manipulate it as required by the procedure. In order to perform stomach retraction in laparoscopic procedures, a variety of clamps and clamp manipulation devices have been designed. Such devices are inserted through the trocars and are used to externally grasp the stomach and pull the stomach in the desired direction. Though workable, the use of such clamps is traumatic, frequently causing hematoma to the stomach wall, lacerations of the stomach surface, and occasionally puncturing the stomach wall. Such punctures can cause leaks and lead to peritonitis. Moreover, the use of such external clamps requires additional incisions through the abdominal wall increasing the number of trocars in order to accommodate one or more of the clamps to provide a desired retraction.
For these reasons, it would be desirable to provide alternative methods and devices for retracting the patient's stomach during laparoscopic and other surgical procedures. It would be particularly desirable if the methods and devices caused minimal or no trauma to the stomach and did not require access penetrations through the abdominal wall. Such methods and devices should preferably be introduced through the esophagus after the induction of anesthesia and permit retraction of the stomach by manipulation of controls affixed to the proximal end of the device which lies externally to the patient. The devices and methods should further provide for a wide degree of motion within the stomach in order to selectively retract an exposed portion of the external stomach to the laparoscopic viewing field.
2. Description of the Background Art
Transesophageal devices for treating obesity comprising a flexible tube and various structures at the distal end of the flexible tubes are described in U.S. Pat. Nos. 4,133,315; 4,485,805; 4,501,264; and 4,648,383. A gastroenteric feeding tube is described in U.S. Pat. No. 4,769,014 and Reexamination Certificate B1 4,769,014. Detachable balloon catheters are described in U.S. Pat. Nos. 4,311,146; 4,341,218; and 4,517,979.